249602 How much primary care do patients with newly-diagnosed dementia receive? Evidence to help inform Medical Home development

Monday, October 31, 2011: 9:42 AM

Richard Fortinsky, PhD , UConn Center on Aging, University of Connecticut Health Center, Farmington, CT
Pedro Gozalo, PhD , Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, RI
Karen Pasquale, MPH , Connecticut Center for Primary Care, Inc., Farmington, CT
John Lynch, MPH , Connecticut Center for Primary Care, Inc., Farmington, CT
Background: Interventions have been developed to augment primary care physician (PCP)-led Medical Homes for patients with diagnosed dementia, yet little is known about types and costs of usual PCP care for these patients. As part of a larger study to augment Medical Homes for community-dwelling dementia patients, we determined total PCP-billed charges in all settings over 12 months following diagnosis.

Methods: We identified newly-diagnosed dementia patients between January 2007-June 2008 in four community-based PCP sites, using a uniform electronic billing system to identify incident dementia-associated ICD-9 codes. For each patient, billing codes and charges were grouped into PCP encounters in office, home care, hospital, and nursing home settings.

Results: Patients (n=113) included 61% women; mean age=82(+8.3) years. Race/ethnicity was unavailable; 90% had fee-for-service Medicare insurance. Alzheimer's disease was the most common dementia diagnosis; most common comorbidities were hypertension and atrial fibrillation. During the post-diagnosis year: patients had a mean=4.8 office visits; 38% were (re)certified for home health care; 23% saw their PCP in a nursing home; 20% received home visits from PCP-affiliated nurse practitioners; 20% saw their PCP in hospital. Mean per-patient charges for all PCP services were $1,822 (sd=$1,397; range=$109-$9,953).

Conclusions: Patients with newly-diagnosed dementia generate highly variable charges from PCP encounters in numerous settings during the post-diagnosis year. To help advance Medical Homes for dementia patients, per-patient PCP-generated charges, as well as adverse outcomes such as hospitalizations and nursing home admissions, under usual care conditions should be compared to those for patients enrolled in augmented PCP-led Medical Homes.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1. Explain how primary care costs can be determined for older patients with new diagnoses of Alzheimer's disease and other dementia. 2. Discuss ways to augment usual primary care to develop Medical Homes for patients with diagnosed dementia.

Keywords: Dementia, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have extensive experience directing and evaluating dementia care studies in primary care and other community-based settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.